One of the questions I received last week was about dealing with and recovering from back pain after having a baby. This is a good topic because not everyone who has back pains after they delivered their baby is because of their pregnancy. Over 80 million Americans suffer from back pain, which is a very large number. So, pregnancy itself does not necessarily cause back pain.
There are, however, things that happened during your pregnancy that can contribute and aggravate your back pain and I will discuss it in this blog.
What Happens To Your Body During Pregnancy
The first thing that happens during pregnancy is our ligaments loosen. A hormone called relaxin gets released when we are pregnant and the ligaments, which attach bone to bone, loosen because of this. Ligaments loosen during pregnancy because they are trying to create space in your pelvis for the baby to grow. However, the loosening of our ligaments in our pelvis also affects other joints and ligaments in our body. Hormones are not able to just go to one specific area in our body as they spread all over. So when our ligaments loosen, it causes instability within the joints.
Instability is not necessarily a bad thing. In the past, I gave the example about spraining your ankle. When this happens, your ligaments will stretch and loosen up, so you just need to strengthen the muscles around that ankle to support that ligament. Ligaments never shrink down in size unless you have a specific surgery to do that. Relating this to when you have instability in the pelvis and in the joints of your low back and you do not have the strength to support that, sometimes back pain can start to occur.
Another factor in back pain after or even during pregnancy is changes to your pelvic floor muscles. This is not my area of expertise, but what I will say is that if you’ve done the standard things to try and fix your back pain with a physical therapist, a chiropractor, any health care provider, or even a personal trainer and it’s not working, then I recommend checking in with a pelvic floor therapist. I think for a long time we thought that the pelvic floor muscles became loose after pregnancy, but a lot of times they actually become tight. This can sometimes contribute to your back pain, so I highly recommend checking in with a pelvic floor physical therapist as they can help to strengthen or help your pelvic floor muscles to relax so your back pain can decrease.
More on the instability of your ligaments, hand in hand during pregnancy the other thing that happens is that your muscles, particularly our abdominal muscles, stretch out because again, they are making space for the baby. So when they stretch out, they lose their tension and they are not quite as taught as they were before. Another thing that can happen is diastasis recti. The expansion in this area could sometimes not be the problem, but the problem could be if there is not enough tension. So something you can look out for after pregnancy is if the tension has not kind of come back because it can affect your back pain.
Since those muscles are losing their tension during pregnancy, what you can do is to start strengthening those areas again so that you can support your back post-partum.
One more thing to consider is that if you are a new parent and you are breastfeeding, you want to check the position you are sitting in. If you are sitting in a slumped position, it will not cause you back pain but it will contribute to worsening having pain in your low back. So you want to get yourself positioned in a way to not increase load to your low back.
What You Can Do After You Give Birth
I do not recommend after you give birth that you get into strengthening right away. Your body needs time to recover.
For me, I had a C-section and I compare it to an anterior cruciate ligament (ACL) surgery. With an ACL surgery, it takes around a full year to completely feel normal again and that’s when I tell people when they had a C-section. It does not mean you cannot move your body, but when doctors give you the go-ahead at the six-week mark, it means you can do light activities and not to return to your activities in full steam. You have to consider that even if you were an active person during your pregnancy, towards the end of it you are slowing down. So your muscles may have atrophied a little bit so it is necessary to slowly increase strengthening activities, so that you can get back to the activities you were doing before.
I personally play tennis and I want to share with you what it looked like for me before I got back to the court. Eight weeks after my C-section, I started doing some very gentle core and glute strengthening activities. I also focused on engaging my pelvic floor to start to slowly strengthen my muscles back up. I also walked almost every day to help with my recovery.
About four months post-partum is when I stepped foot on the tennis court again for the first time. I only played for ten minutes and I only played short court. I did not go all out when I got back to my activity as I did a very small amount on the court. I then increased it slowly and when I was around seven months post-partum, I was finally hitting for a full hour on the tennis court. During the one-year mark, I was playing competitive matches again.
Just gauge how you want to slowly get back into your activities post-partum. If it has been a couple years after you had your kids and you are still experiencing back pain, you want to get yourself on a good strengthening and conditioning program. It does not even have to take more than twenty minutes or more than four times a week. Such program will help you start alleviate your back pain you are experiencing because the muscles will begin to come online again and take the load off your back.
The final thing to consider with back pain, especially if it has been a few years since you have had your kids, is your stress level. If you are super stressed out and your cup is empty, we are more likely to experience pain. You want to make sure that you do things to fill your cup and to take time for yourself as this can also help with your back pain equally as much as doing strengthening. This is one of the reasons why I really love doing yoga because such activity decreases your stress, while also increases your strength.
If you tried some of these things but nothing is working, check in with your physical therapist as you might have more particular needs and it might be necessary to have more specificity in your program to decrease your back pain. Your back pain may be present on and off and going to physical therapy can really help you learn the best ways to manage your back pain.